The course of apathy in late-life depression treated with electroconvulsive therapy; a prospective cohort study.

OBJECTIVES: Apathy, a lack of motivation, is frequently seen in older individuals, with and without depression, with substantial impact on quality of life. This prospective cohort study of patients with severe late-life depression treated with electroconvulsive therapy (ECT) aims to study the course of apathy and the predictive value of vascular burden and in particular white matter hyperintensities on apathy course. METHODS: Information on apathy (defined by a score of >13 on the Apathy Scale), depression severity, vascular burden, and other putative confounders was collected in at 2 psychiatric hospitals on patients with late-life depression (aged 55 to 87 years, N = 73). MRI data on white matter hyperintensities were available in 52 patients. Possible risk factors for apathy post-ECT were determined using regression analyses. RESULTS: After treatment with ECT, 52.0% (26/50) of the depression remitters still suffered from clinically relevant apathy symptoms. In the entire cohort, more patients remained apathetic (58.9%) than depressed (31.5%). Presence of apathy post-ECT was not associated with higher age, use of benzodiazepines, or severity of apathy and depression at baseline. Less response in depressive symptomatology after ECT predicted post-treatment apathy. The presence of vascular disease, diabetes mellitus and smoking, and white matter hyperintensities in the brain was not associated with post-treatment apathy. CONCLUSIONS: Apathy may perpetuate in individual patients, despite remission of depressive symptoms. In this cohort of patients with late-life depression, post-ECT apathy is not associated with white matter hyperintensities.

Exposing the third chromosome of Burkholderia cepacia complex strains as a virulence plasmid.

The Burkholderia cepacia complex (Bcc) consists of 17 closely related species of opportunistic bacterial pathogens, which are particularly problematic for cystic fibrosis patients and immunocompromised individuals. Bcc genomes consist of multiple replicons, and each strain sequenced to date has three chromosomes. In addition to genes thought to be essential for survival, each chromosome carries at least one rRNA operon. We isolated three mutants during a transposon mutagenesis screen that were non-pathogenic in a Caenorhabditis elegans infection model. It was demonstrated that these mutants had lost chromosome 3 (c3), and that the observed attenuation of virulence was a consequence of this. We constructed a c3 mini-replicon and used it to cure c3 from strains of several Bcc species by plasmid incompatibility, resulting in nine c3-null strains covering seven Bcc species. Phenotypic characterization of c3-null mutants revealed that they were attenuated in virulence in multiple infection hosts (rat, zebrafish, C. elegans, Galleria mellonella and Drosophila melanogaster), that they exhibited greatly diminished antifungal activity, and that c3 was required for d-xylose, fatty acid and pyrimidine utilization, as well as for exopolysaccharide production and proteolytic activity in some strains. In conclusion, we show that c3 is not an essential chromosomal element, rather a large plasmid that encodes virulence, secondary metabolism and other accessory functions in Bcc bacteria.

[Macro replantation of upper extremity. Update and review of the long-term functional results]. / Macro-réimplantation de membre supérieur. Mise au point et résultat fonctionnel a très long-terme.

Confronted with increasing problems of financing in health care, some question the relevance of certain interventions of high technicality. Today, the limiting factor for practitioners is not any longer situated at the technical and technological level (the survival of macro replantations is assured in 85-90%) but moves slowly and surely towards the economic level. It is true that medicine has a price and that if a technique is expensive, it should at least be justified at the human level and superior to other less expensive therapeutic options which are available. In this article, we will first focus on the long-term outcome of patients and also on the functional benefit which brings them replantation compared to patients who underwent a regularization of their stump and possibly a reconstruction enabling them to be correctly fitted with a prosthesis.

[Patient complaints in a hospital emergency department in Belgium]. / Typologie des plaintes déposée dans un service d'urgences en Belgique.

Patients express their dissatisfaction through complaints. This study analyzed the frequency and chief complaints of patients presenting to the emergency department (ED). The end point was find ways to improve patient satisfaction after their ED visit. In this retrospective, seven years study, we reviewed 155 chief complaints of patients presenting to the ED of a university hospital. The chief complaints were either from the patients or a family member. One hundred and fifty five chief complaints collected from 496.816 patients presenting to the ED were reviewed over a period of seven years. Complaints case rate was 3.1 per 10.000 visits. Complaints came from patients between the age of 20 to 60 years old (75.0 percent). Complains involved a physician (79.0 percent). The complaints were related a lack of communication (39.0 percent), long waiting time (14.0 percent), wrong diagnosis (22.0 percent), wrong treatment (13.0 percent) and ED disposition of the patient (12.0 percent). Two types of pathology represented more than 15 percent of the complaints: the traumatology (22.0 percent) and the psychiatry (17.0 percent). The traumatology and psychiatry represented respectively 30.0 percent and 10.0 percent of ED visits. Most complaints were addressed and resolved through a hospital mediator, Chief of service or Chief of staff. The rate of complains is low. Most complaints can be prevented if the physician improves communication with patients.

On the influence of cell shape on dynamic reaction-diffusion polarization patterns.

The distribution of signaling molecules following mechanical or chemical stimulation of a cell defines cell polarization, with regions of high active Cdc42 at the front and low active Cdc42 at the rear. As reaction-diffusion phenomena between signaling molecules, such as Rho GTPases, define the gradient dynamics, we hypothesize that the cell shape influences the maintenance of the "front-to-back" cell polarization patterns. We investigated the influence of cell shape on the Cdc42 patterns using an established computational polarization model. Our simulation results showed that not only cell shape but also Cdc42 and Rho-related (in)activation parameter values affected the distribution of active Cdc42. Despite an initial Cdc42 gradient, the in silico results showed that the maximal Cdc42 concentration shifts in the opposite direction, a phenomenon we propose to call "reverse polarization". Additional in silico analyses indicated that "reverse polarization" only occurred in a particular parameter value space that resulted in a balance between inactivation and activation of Rho GTPases. Future work should focus on a mathematical description of the underpinnings of reverse polarization, in combination with experimental validation using, for example, dedicated FRET-probes to spatiotemporally track Rho GTPase patterns in migrating cells. In summary, the findings of this study enhance our understanding of the role of cell shape in intracellular signaling.

[The anatomical laboratory: a tool for the trial of the new therapeutic procedures]. / Le laboratoire d'anatomie: un banc d'essai des nouvelles technologies.

Since September 2009, the new anatomical department is located on the CHU building. This modern anatomical laboratory is an effective tool to design the new therapeutic procedures and to teach these procedures to practitioners.

Mini wing osteotomy: A variant of chin wing osteotomy.

The mini wing is a variant of the chin wing osteotomy. Its design extends from the chin region to the horizontal branch of the mandible as in a traditional chin wing. However, the posterior most cut ends on the upper part of the mandibular notch. It corresponds to a shortened chin wing that respects the basilar edge of the mandible. Its advantage is the capacity to associate it with a bilateral sagittal split osteotomy (BSSO) in the global management of dento-skeletal deformity. There is no contraindication to the realization of a mini wing. Contrarily to the traditional chin wing, a very low positioned inferior alveolar nerve (IAN) is not a contraindication to the mini wing.

Five-year mortality in patients with diabetic foot ulcer during 2009-2010 was lower than expected.

AIM: Mortality rates are decreasing in patients with diabetes. However, as this observation also concerns patients with diabetic foot ulcer (DFU), additional data are needed. For this reason, our study evaluated the 5-year mortality rate in patients with DFU during 2009-2010 and identified risk factors associated with mortality. METHODS: Consecutive patients who attended a clinic for new DFU during 2009-2010 were followed until healing and at 1 year. Data on mortality were collected at year 5. Multivariate Cox proportional-hazards model was used to identify mortality risk factors. RESULTS: A total of 347 patients were included: mean age was 65±12 years, diabetes duration was 16 [10; 27] years; 13% were on dialysis; and 7% had an organ transplant. At 5 years, 49 patients (14%) were considered lost to follow-up. Total mortality rate at 5 years was 35%, and 16% in patients with neuropathy. On multivariate analyses, mortality was positively associated with: age [hazard ratio (HR): 1.05 (1.03-1.07), P<0.0001]; duration of diabetes [HR: 1.02 (1.001-1.03], P=0.03]; PEDIS perfusion grade 2 vs. 1 [HR: 2.35 (1.28-4.29), P=0.006)]; PEDIS perfusion grade 3 vs. 1 [HR: 3.14 (1.58-6.24), P=0.001); and ulcer duration at year 1 [HR 2.09 (1.35-3.22), P=0.0009]. CONCLUSION: Mortality rates were not as high as expected despite the large number of comorbidities, suggesting that progress has been made in the health management of these patients. In particular, patients with neuropathic foot ulcer had a survival rate of 84% at 5 years.

Orthodontic - Surgical management in a Class II case with idiopathic root resorption.

Patients with root resorption and malocclusion can benefit from orthodontic treatment with or without surgery. However, orthodontics has a risk of inducing or aggravating root resorption, therefore the duration of the treatment is of utmost importance. In this paper, a surgery-first protocol with lower jaw advancement and precise interdental alveolar osteotomies was conducted to accelerate the treatment of a 14-year-old female patient who presented with a Class II division 2 malocclusion, anterior dental crowding and idiopathic root resorption. One week after the surgery, the patient received postoperative orthodontic treatment for 6 months with weekly activation the first month. The clinical outcome was satisfactory with complete clinical resolution and no tooth loss. This surgery approach allowed an 'en bloc' tooth movement and induced an increased bone remodelling, which resulted in an accelerated tooth movement. The reduction of treatment time was beneficial and no aggravation of the root resorption was seen.

In silico clinical trials for pediatric orphan diseases.

To date poor treatment options are available for patients with congenital pseudarthrosis of the tibia (CPT), a pediatric orphan disease. In this study we have performed an in silico clinical trial on 200 virtual subjects, generated from a previously established model of murine bone regeneration, to tackle the challenges associated with the small, pediatric patient population. Each virtual subject was simulated to receive no treatment and bone morphogenetic protein (BMP) treatment. We have shown that the degree of severity of CPT is significantly reduced with BMP treatment, although the effect is highly subject-specific. Using machine learning techniques we were also able to stratify the virtual subject population in adverse responders, non-responders, responders and asymptomatic. In summary, this study shows the potential of in silico medicine technologies as well as their implications for other orphan diseases.

[Influence of body mass index on outcome of total hip arthroplasty via a minimally invasive anterior approach]. / Influence de l'indice de masse corporelle sur la réalisation d'une prothèse totale de hanche par voie d'abord antérieure réduite.

PURPOSE OF THE STUDY: The purpose of this prospective study was to evaluate the influence of the BMI on the feasibility of minimally invasive total hip arthroplasty (THA). MATERIAL AND METHODS: This prospective study included 86 patients (88 THA) operated on via a single minimally invasive incision (7 cm) using an anterior approach on Judet's orthopedic table. Mean age was 63.7 years and mean BMI was 58.8. Forty-one patients were classified in group I (BMI<25) and 46 in group II (BMI >=25). Perioperative data, pain, postoperative blood loss, duration of the procedure, and length of the incision were noted. All patients were reviewed at three months and radiographic analysis was performed to asses the position of the socket and the quality of the cementation. RESULTS: BMI did not appear to be a strict contraindication for a minimally invasive procedure. Nevertheless, bleeding and operative duration were statistically correlated with BMI (epsilon=4.28 and epsilon=2.66). Extension of the wound noted at the end of the procedure in patients with BMI > =25 (t=5.01) may have resulted from greater pressure on the skin and soft tissue due to stronger traction and more abrasion of the skin edges by reamers and rasps. Such damage may lead to more wound complications even though in our experience there was no statistical difference. On the other hand, socket position and cementation did not appear to be correlated with BMI. DISCUSSION: Results concerning duration of procedure, bleeding, hospital stay and rate of complications are contradictory in the literature. At the same time, criteria for patient selection remain unclear. It thus appeared to be of interest to determine whether BMI was a good criterion to determine the feasibility of THA via a minimally invasive procedure. CONCLUSION: BMI appears to be a good criterion to evaluate the risk of wound complications after minimally invasive surgery. On the other hand, other criteria must be found since BMI does not evaluate muscle mass which seems to be of major concern in minimally invasive procedures.

Erratum: Capturing the wide variety of impaired fracture healing phenotypes in Neurofibromatosis Type 1 with eight key factors: a computational study.

This corrects the article DOI: 10.1038/srep20010.

Capturing the wide variety of impaired fracture healing phenotypes in Neurofibromatosis Type 1 with eight key factors: a computational study.

Congenital pseudarthrosis of the tibia (CPT) is a rare disease which normally presents itself during early childhood by anterolateral bowing of the tibia and spontaneous tibial fractures. Although the exact etiology of CPT is highly debated, 40-80% of CPT patients are carriers of a mutation in the Neurofibromatosis Type 1 (NF1) gene, which can potentially result in an altered phenotype of the skeletal cells and impaired bone healing. In this study we use a computational model of bone regeneration to examine the effect of the Nf1 mutation on bone fracture healing by altering the parameter values of eight key factors which describe the aberrant cellular behaviour of Nf1 haploinsufficient and Nf1 bi-allelically inactivated cells. We show that the computational model is able to predict the formation of a hamartoma as well as a wide variety of CPT phenotypes through different combinations of altered parameter values. A sensitivity analysis by "Design of Experiments" identified the impaired endochondral ossification process and increased infiltration of fibroblastic cells as key contributors to the degree of severity of CPT. Hence, the computational model results have added credibility to the experimental hypothesis of a genetic cause (i.e. Nf1 mutation) for CPT.

The rye embryo system as an alternative to the wheat system for protein synthesis in vitro.

Isolated rye embryos are a readily available source for the preparation of very active, cell-free, protein-synthesizing systems. Incorporation levels up to 2000 pmol leucine per 50 mul assay are routinely obtained at saturating TMV (Tobacco mosaic virus) RNA concentrations; at limiting messenger RNA concentrations the incorporation exceeds 1000 leucine molecules per TMV RNA molecule. The characteristics of this cell-free system for the translation of TMV RNA are identical with those of a similarly prepared wheat germ system. The major advantage of the rye embryo system is its high reliability as compared to the unpredictable wheat germ system. Sucrose gradient analysis of the reaction mixture during the incubation shows an extensive polysome formation with TMV RNA and demonstrates efficient polypeptide chain release.

Some properties of trehalase from Phycomyces blakesleeanus.

Trehalase (alpha, alpha-trehalase glucohydrolase EC 3.2.1.28) from Phycomyces spores occurs in two different forms which are convertible in vivo: a form with low activity found in dormant spores and an active form after breaking the dormancy. Between the two forms no difference in molecular weight and electrophoretic mobility can be detected. The molecular weight is estimated by gel filtration at about 210 000. The relation between substrate concentration and trehalase activity follows the Michaelis-Menten equation (K-m plus or minus 55 mM) in activated spores whereas in dormant spores trehalase shows a different substrate binding, indicating a negative cooperative effect. They differ further in thermostability and in sensitivity to inhibition by ATP. Other nucleosidephosphates have no inhibiting effect. Heating the spores at different temperatures between 38 and 44 degrees C results in a partial breaking of dormancy of the spore population and a corresponding partial activation of trehalase. This suggests a close connection between breaking dormancy and trehalase activation.

[The need of emergency services for the hand]. / De la nécéssité des services d'urgence de la main.

Microsurgical techniques have been able to realize anastomoses of small vessels and nerves, with a high rate of success when performed by teams involved in that field. This has changed the concept of surgery of the hand. Reconstruction aims now at a functional result. Organisation of emergencies in hand surgery requires facilitations: hand surgeons, equipment and a team on a 24-hour basis, able to operate any kind of hand trauma. Since 1979, Liége is affiliated to the European Federation. Advantages of the immediate repair are significant repair are significant: reduction of the permanent disability rate, and in many instances, return to work at the same position. In conclusion, early treatment of the injuries of the hand is very effective, but need to be performed by specialists in the field of hand surgery.

[Current emergency treatment of lesions of the flexor tendons: anatomical, biomechanical and cicatricial aspects]. / Traitement actuel des lésions des tendons fléchisseurs en urgence: les notions anatomiques, biomécaniques et cicatricielles.

Emergency treatment of flexor tendon lesion in 1988: anatomic biomechanical and healing characteristics. Flexor tendon surgery in 1988 must take into account detailed anatomic knowledge as well as healing and biomechanical properties of flexor tendons. Application of standardised surgical technics allows reliable treatment when the surgeon is familiar with these technics and the basic knowledge they suppose. The authors detail the technics and certain details with practical goals.